A meta-analytic review of racial-ethnic matching for African American and Caucasian American clients and clinicians

Shin S M, Levy R J, Chow C, Camacho-Gonsalvez T, Allen I E, Leff H S

CRD summary

This review evaluated the effectiveness of racial-ethnic matching on functioning, service retention and attendance for African and Caucasian Americans receiving mental health services. The authors concluded that there was no significant difference between racial-ethnic matching and no-matching. The small number of studies of unknown quality, the departure from the inclusion criteria, and the lack of methodological details suggest the results may not be reliable.

Authors' objectives

To evaluate the effectiveness of client-clinician matching on the basis of race-ethnicity on overall functioning, service retention, and the total number of sessions attended for African American and Caucasian American adults in mental health services.

Searching

MEDLINE, PsycINFO/PsycLIT and ProQuest were searched; the search terms were reported. The authors stated that unpublished dissertations were also sought.

Study selection

Study designs of evaluations included in the review

Studies using an experimental or quasi-experimental design were eligible for inclusion.

Specific interventions included in the review

Studies of racial-ethnic matching in mental health systems were eligible for inclusion.

Participants included in the review

Studies of African Americans and Caucasian Americans of European heritage receiving psychotherapy were eligible for inclusion. The review included seven studies of psychotherapy, two of case management and one with mixed treatments. In studies where the matching of the participants was not reported clearly, the authors were contacted for further information. Nine of the studies were conducted in out-patient settings, while the other was set in a combination of out-patient and residential settings.

Outcomes assessed in the review

Studies had to report attrition, the total number of sessions of psychotherapy attended, and psychosocial functioning as defined by the Global Assessment of Functioning scale, or a similar score. The included studies measured psychosocial functioning using the clinician-rated Global Assessment Scale and client-rated measures including the General Severity Index, Brief Symptoms Inventory and the Addiction Severity Composite Score.

How were decisions on the relevance of primary studies made?

The authors did not state how the papers were selected for the review, or how many reviewers performed the selection.

Assessment of study quality

The authors did not state that they assessed validity.

Data extraction

Two reviewers independently extracted the data for the review, with any disagreements resolved by consensus. Standardised mean differences (SMDs) and 95% confidence intervals (CIs) were calculated for each study.

Methods of synthesis

How were the studies combined?

The pooled SMD and 95% CI were calculated using a random-effects meta-analysis.

How were differences between studies investigated?

Heterogeneity was assessed statistically using the Q statistic. Forest plots were provided for visual inspection of heterogeneity. The review assessed the outcomes separately for African Americans and Caucasian Americans.

Results of the review

Ten studies were included in the review (n=16,570 plus 60 families). The authors stated that nine of the included studies were completed under a descriptive or non-experimental design, with the other being of a quasi-experimental design.

In most studies it was unclear how the clients were matched to the clinicians.

Attrition (3 studies).

There was no overall statistically significant difference in attrition between matched and unmatched African American (3 studies) or Caucasian American (2 studies) participants. Statistically significant heterogeneity was seen in both analyses.

Total number of sessions of psychotherapy attended (8 studies).

There was no overall statistically significant difference in the number of sessions attended between matched and unmatched African American (8 studies) or Caucasian American (4 studies) participants. Statistically significant heterogeneity was seen in both analyses.

Psychosocial functioning (6 studies).

There was no overall statistically significant difference in post-treatment psychosocial functioning between matched and unmatched African American (6 studies) or Caucasian American (3 studies) participants. Statistically significant heterogeneity was seen in both analyses.

Authors' conclusions

There was no significant difference in overall functioning, service retention and the total number of sessions attended, between racial-ethnic matched and unmatched consultations for African American or Caucasian American clients.

CRD commentary

Three relevant electronic databases were searched in an attempt to located both published and unpublished studies. The authors gave no indication as to whether language restrictions were applied, and did not investigate publication bias. The inclusion criteria were not adhered to: the inclusion criteria stated that studies of participants having psychotherapy were eligible, but three studies were of participants receiving other interventions. The authors also stated that experimental and quasi-experimental designs were eligible for inclusion, but went on to say that nine of the ten studies were completed under a descriptive or non-experimental design, and that either the participants were not randomly assigned or the study did not contain a comparison group. The authors did not appear to have assessed validity, and details of the designs of the included studies were not explicitly stated.

The data extraction was carried out in duplicate, thus reducing the potential for error and bias. However, it was unclear whether the same precautions were used when selecting the studies. It was also unclear whether it was appropriate to pool the results, owing to the statistical heterogeneity and lack of study details to evaluate clinical heterogeneity. Given the small number of studies of unknown quality, the departure from the inclusion criteria, and the lack of details on the method used for study selection, the results may be unreliable and should be treated with caution.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors recommended that future studies of racial-ethnic matching should investigate the impact of factors such as acculturation, education and gender, and should report more information on the nature of the service delivered, and the characteristics of the clinicians and clients.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.